Endocarditis

ʻO Endocarditis ka mumū o ka pale o loko o nā keʻena o ka puʻuwai a me nā puʻuwai puʻuwai (endocardium). Hoʻokumu ʻia ia e kahi maʻi bacteria a i ʻole, ʻano iki ʻole kahi maʻi fungal.

Hiki i ka endocarditis ke hoʻopili i ka puʻuwai puʻuwai, nā puʻuwai puʻuwai, a i ʻole ka pale o ka puʻuwai. ʻO kekahi poʻe e hoʻomohala i ka endocarditis he:

• Hema hānau o ka puʻuwai
• Poino puuwai poino a i ʻole maikaʻi ʻole
• Mōʻaukala endocarditis
• Pākuʻi puʻuwai hou ma hope o ke kaha ʻana
• Pāpā lāʻau makua (intravenous)

Hoʻomaka ka endocarditis i ke komo ʻana o nā mikamina i loko o ke kahe o ke koko a laila huakaʻi i ka puʻuwai.

• ʻO ka maʻi maʻi bacteria ke kumu maʻamau o ka endocarditis.
• Hiki ke kumu ʻia ka endocarditis e nā fungi, e like me Candida.
• I kekahi mau hihia, ʻaʻole hiki ke loaʻa kahi kumu.

E komo paha ʻo Kelemona i ke kahe o ke koko i ka wā:

• Nā laina komo vna kikowaena
• Hoʻohana ka lāʻau hoʻōla, mai ka hoʻohana ʻana i nā nila kolohe ʻole (unsterile)
• ʻOki kino niho hou
• ʻO nā ʻoki lāʻau ʻē aʻe a i ʻole nā ​​kaʻina hana liʻiliʻi i ka hanu hanu, ka maʻi urinary, ka ʻili i pā ʻia, a i ʻole nā ​​iwi a me nā mākala

Hiki ke ulu lohi a i ʻole hikiwawe paha nā ʻōuli o ka endocarditis.

ʻO ka fiva, ke anuanu, a me ka hou ka pinepine. Hiki i kēia mau manawa ke:

• E noho no nā lā ma mua o ka hōʻike ʻana o kekahi hōʻailona
• Hele a hele, a ʻike ʻia paha i ka pō

Loaʻa paha iā ʻoe ka luhi, nāwaliwali, a me nā ʻeha a me nā ʻeha i nā mākala a me nā hono.

Hiki i nā hōʻailona ʻē aʻe ke hoʻopili pū me:

• Nā wahi liʻiliʻi o ke kahe ʻana ma lalo o nā kui (splinter hemorrhages)
• ʻO nā ʻili ʻulaʻula, ʻeha ʻole ma nā lima a me nā kapuwaʻi (lesion Janeway)
• ʻUlaʻula, ʻeha nā pona i nā pale o nā manamana lima a me nā manamana wāwae (Osler node)
• Ka hanu ʻana me ka hana
• ʻO ka pehu ʻana o nā wāwae, nā wāwae, a me nā ʻōpū

Kuhi paha ka mea mālama ola i kahi ʻōhumu o ka puʻuwai hou, a i ʻole ka loli i kahi ʻōhumu puʻuwai i hala.

Hōʻike paha kahi hoʻokolohua maka i ke kahe ʻana o ka retina a me kahi kikowaena o ka hoʻomaʻemaʻe. ʻIke ʻia kēia ʻike ma ke ʻano he mau kiko Roth. Aia paha he mau wahi liʻiliʻi, kikoʻī o ke kahe ʻana ma ka ʻili o ka maka a i ʻole nā ​​lihilihi.

ʻO nā hoʻāʻo e hana ʻia ana paha:

• ʻO ka moʻomeheu koko e kōkua e ʻike i ke koʻohune a i ʻole ka fungus e hoʻomaka nei i ka maʻi
• Helu piha ke koko (CBC), protein C-reactive (CRP), a i ʻole ka erythrocyte sedimentation rate (ESR)
• ʻO kahi echocardiogram e nānā i nā kiʻina puʻuwai

Pono paha ʻoe i ka haukapila e kiʻi i nā lāʻau ʻalopika ma o ke aa (IV a i ʻole intravenously). E kōkua nā moʻomeheu koko a me nā hoʻāʻo i kāu mea hāʻawi e koho i ka antibiotic ʻoi loa.

A laila makemake ʻoe i kahi lāʻau antibiotic lōʻihi lōʻihi.

• Pono ka poʻe pinepine i ka lāʻau no 4 a 6 mau pule e pepehi i nā maʻi āpau mai nā keʻena puʻuwai a me nā kiwikā.
• Pono e hoʻomau ʻia nā lāʻau Antibiotic i hoʻomaka ʻia i ka haukapila ma ka home.

ʻO ke ʻoki kino e pani ai i ka nohona naʻau e pono pinepine ai i ka wā:

• Ke haki nei ka maʻi i nā ʻāpana liʻiliʻi, a laila loaʻa nā hahau.
• Hoʻolālā ke kanaka i ka maikaʻi ʻole o ka puʻuwai ma muli o nā valves puʻuwai i hōʻino ʻia.
• Aia nā hōʻike o ka hōʻino ʻino nui o nā ʻola.

ʻO ka loaʻa ʻana o ka lāʻau no ka endocarditis i kēia manawa e hoʻomaikaʻi i nā manawa o kahi hopena maikaʻi.

ʻO nā pilikia nui aʻe e hoʻomohala pū me:

• Holo ka lolo
• ʻO ka hōʻino hou aʻe i nā kiwikā o ka puʻuwai, e hōʻeha ana i ka puʻuwai
• Hoʻolahalaha ka maʻi i nā ʻāpana ʻē aʻe o ke kino
• ʻO ka hahau, i hoʻokumu ʻia e nā clots liʻiliʻi a i ʻole nā ​​ʻāpana o ka maʻi i haki a hele i ka lolo

Kāhea i kāu mea hāʻawi inā ʻike ʻoe i kēia mau hōʻailona ma hope a ma hope paha o ka mālama ʻana.

• Koko i ka mimi
• ʻEha ʻeha
• Ka luhi
• ʻAʻole hele ka fiva
• Fiva
• Pōpō
• Nawaliwali
• ʻO ka pohō kaumaha me ka loli ʻole o ka papaʻai

Paipai ka American Heart Association i nā lāʻau ʻaloʻalo pale no ka poʻe i pilikia no ka endocarditis infectious, e like me nā mea me:

• Kekahi hānau kīnā o ka puʻuwai
• Hoʻopilikia i ka hoʻoliʻiliʻi naʻau a me nā pilikia
• ʻO nā valves puʻuwai Prosthetic (nā valves puʻuwai i hoʻokomo ʻia e kahi mea lapaʻau)
• ʻO ka mōʻaukala i hala o endocarditis

Pono i kēia poʻe e loaʻa nā lāʻau antibiotic ke loaʻa iā lākou:

• Kahua niho nā kaʻina hana e paha e kumu kahe ana ke koko
• Nā hana e pili ana i ka hanu hanu
• Nā hana e pili ana i ka ʻōnaehana urinary tract
• Nā hana e pili ana i ka digestive tract
• Nā hana e pili ai i nā maʻi ʻili a me nā maʻi palupalu

Pākuʻi Valve; Staphylococcus aureus - endocarditis; Enterococcus - endocarditis; Streptococcus viridans - endocarditis; Candida - endocarditis

• ʻO ke kīpoki puʻuwai puʻuwai - hoʻokuʻu

• Puʻuwai - ʻāpana ma waena o ka waena
• Puʻuwai - ʻike mua
• Liona Janeway - pili loa
• Liona Janeway ma ka manamana lima
• Nā nohona puʻuwai

Baddour LM, Freeman WK, Suri RM, Wilson WR. Nā maʻi maʻi Cardiovascular. I: Zipes DP, Libby P, Bonow RO, Mann DL, Tomaselli GF, Braunwald E, eds. ʻO ka maʻi puʻuwai ʻo Braunwald: He puke aʻo no ka lāʻau Cardiovascular. 11th hua. Piladelapia, PA: Elsevier; 2019: chap 73.

Baddour LM, Wilson WR, Bayer AS, et al. ʻO ka endocarditis infective i nā mākua: diagnose, antimicrobial therapy, a me ka mālama ʻana i nā pilikia: kahi ʻōlelo ʻepekema no nā ʻoihana olakino mai ka American Heart Association. Kaapuni. 2015; 132 (15): 1435-1486. PMID: 26373316 www.ncbi.nlm.nih.gov/pubmed/26373316.

ʻO Fowler VG, Bayer AS, Baddour LM. Endocarditis infective. I: Goldman L, Schafer AI, eds. ʻO ka lāʻau lapaʻau Goldman-Cecil. 25th hua. Piladelapia, PA: Elsevier Saunders; 2016: chap 76.

ʻO Fowler VG, Nānā WM, Bayer AS. Endocarditis a me nā maʻi maʻi maʻi. I: Bennett JE, Dolin R, Blaser MJ, hua pā. ʻO Mandell, Douglas, a me Bennett's Principle a me ka hoʻomaʻamaʻa ʻana i nā maʻi kūpilikiʻi. 8th ed. Piladelapia, PA: Elsevier Saunders; 2015: chap 82.